1
|
Screening for Bacterial Vaginosis in Pregnant Persons to Prevent Preterm Delivery: Recommendation Statement. Am Fam Physician 2020; 102:105-9. [PMID: 32667170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
2
|
Poon LC, Abramowicz JS, Dall'Asta A, Sande R, Ter Haar G, Maršal K, Brezinka C, Miloro P, Basseal J, Westerway SC, Abu-Rustum RS, Lees C. ISUOG Safety Committee Position Statement on safe performance of obstetric and gynecological scans and equipment cleaning in context of COVID-19. Ultrasound Obstet Gynecol 2020; 55:709-712. [PMID: 32207189 DOI: 10.1002/uog.22027] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- L C Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR
| | - J S Abramowicz
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - A Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - R Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - G Ter Haar
- Therapy Ultrasound, Division of Radiotherapy & Imaging, Joint Department of Physics, Royal Marsden Hospital, Institute of Cancer Research, Surrey, UK
| | - K Maršal
- Department of Obstetrics and Gynecology (Emeritus), Lund University, University Hospital, Lund, Sweden
| | - C Brezinka
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - P Miloro
- Ultrasound and Underwater Acoustics, National Physical Laboratory, Teddington, UK
| | - J Basseal
- Discipline of Infectious Diseases & Immunology, Faculty of Medicine and Health, The University of Sydney; and Australasian Society for Ultrasound in Medicine (ASUM), NSW, Australia
| | - S C Westerway
- School of Dentistry & Health Sciences, Charles Sturt University; and Australasian Society for Ultrasound in Medicine (ASUM), Sydney, NSW, Australia
| | - R S Abu-Rustum
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - C Lees
- Imperial College School of Medicine, Imperial College London, London, UK
| |
Collapse
|
3
|
Hidalgo JJ, Ros F, Aubá M, Errasti T, Olartecoechea B, Ruiz-Zambrana Á, Alcázar JL. Prospective external validation of IOTA three-step strategy for characterizing and classifying adnexal masses and retrospective assessment of alternative two-step strategy using simple-rules risk. Ultrasound Obstet Gynecol 2019; 53:693-700. [PMID: 30353585 DOI: 10.1002/uog.20163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To perform an external validation of the diagnostic performance of the three-step strategy proposed by the International Ovarian Tumor Analysis (IOTA) group for classifying adnexal masses as benign or malignant, when ultrasound is performed by non-expert sonographers in the first two steps. The second objective was to assess the diagnostic performance of an alternative strategy using simple-rules risk (SRR), instead of simple rules (SR), in the second step. METHODS This was a prospective observational study conducted at two university hospitals, from September 2015 to August 2017, of consecutive patients diagnosed with an adnexal mass. All women were evaluated by ultrasound using the IOTA three-step strategy. Non-expert sonographers performed the first step (use of simple descriptors to classify the masses) and the second step (use of SR if the mass could not be classified in the first step); masses that could not be classified in the first two steps were categorized by an expert sonographer based on their subjective assessment (third step). The reference standard was histological diagnosis in patients who underwent surgery or at least 12 months of follow-up in cases managed expectantly. The sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios and overall accuracy of the IOTA three-step strategy were estimated. Furthermore, we evaluated retrospectively an alternative two-step strategy using SRR in the second step to categorize the masses not classifiable with simple descriptors, classifying the lesions as being of low, intermediate or high risk for malignancy. The diagnostic performance of this strategy was estimated by calculating its sensitivity and specificity, assuming surgical intervention for intermediate- or high-risk lesions. RESULTS The study included 283 patients (median age, 48 (range, 18-90) years), of whom 165 (58.3%) were premenopausal and 118 (41.7%) postmenopausal. Two hundred and sixteen (76.3%) women underwent surgery (154 benign and 62 malignant masses) and 67 (23.7%) were managed expectantly with serial ultrasound follow-up for at least 12 months. All expectantly managed masses were considered benign because no sonographic changes suggestive of malignancy were observed during follow-up. Simple descriptors could be applied in 126 (44.5%) masses. Of the remaining 157 lesions, 112 (39.6%) could be characterized using SR. Therefore, 238 (84.1%) masses could be classified by non-expert sonographers in the first two steps. Of the remaining 45 (15.9%) masses, all could be classified by an expert sonographer. Overall sensitivity, specificity, LR+ and LR- of the IOTA three-step strategy were 95.2%, 97.7%, 42.1 and 0.05, respectively. The diagnostic accuracy was 97.2%. Following the two-step strategy using SRR in the second step, of the 157 lesions not classified with simple descriptors, 42, 38 and 77 presented low, intermediate or high risk for malignancy, respectively. Based on this method, 210 women would have undergone surgical treatment. The sensitivity and specificity of this two-step strategy were 98.4% and 63.8%, respectively. CONCLUSIONS The IOTA three-step strategy shows high accuracy for discriminating between benign and malignant adnexal lesions when used by non-expert sonographers. An alternative strategy using the SRR calculator in the second step might improve on this diagnostic performance by decreasing the number of surgical interventions and increasing sensitivity. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- J J Hidalgo
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Unidad Predepartamental de Medicina, Universitat Jaume I. Castellón, Castellón de la Plana, Spain
| | - F Ros
- Unidad Predepartamental de Medicina, Universitat Jaume I. Castellón, Castellón de la Plana, Spain
| | - M Aubá
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - T Errasti
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - B Olartecoechea
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Á Ruiz-Zambrana
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - J L Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| |
Collapse
|
4
|
Tumanyan A, Gemilyan M, Hambartsoumian E. Single and double endometrial scratching (ES) in infertile women with strict criteria of recurrent implantation failure (RIF). Gynecol Endocrinol 2019; 35:11-14. [PMID: 31532321 DOI: 10.1080/09513590.2019.1632085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Controversies surrounding the effect of ES on pregnancy outcome in women with RIF are mostly due to the poorly defined target population. We evaluated the effect of ES on clinical outcomes in women with strict criteria of RIF before IVF/ICSI. We also examined the effect of ES on the expression of markers of endometrial receptivity. Women with failed implantation after transfer of seven or more top quality day 3 embryos or three blastocysts underwent the scratch procedure on exact days of the cycle prior to IVF/ICSI. Results were compared to no scratch control group. Using histopathology, immunohistochemistry, and scanning electron microscopy, we also examined the effect of injury on the endometrial receptivity in a separate series of observations with double ES. Cumulative pregnancy rate was significantly higher in the study group as compared to control (54.8% vs. 29.0%; p < .05). The effect of ES on the clinical outcome was seen during fresh ET, but not on the next FET cycles. ES improves impaired endometrial receptivity by partially normalizing the expression of estrogen and progesterone receptors (ERs, PRs) and pinopodes. We concluded that in a well-defined subpopulation of infertile women with RIF, ES significantly enhances pregnancy rates. ES has a specific impact on endometrial receptivity normalizing the expression of some markers.
Collapse
Affiliation(s)
- Armine Tumanyan
- Fertility Center, Yerevan State Medical University , Yerevan , Armenia
| | - Manik Gemilyan
- Department of Gastroenterology and Hepatology, Yerevan State Medical University , Yerevan , Armenia
| | | |
Collapse
|
5
|
Ferreira AF, Silva CM, Antunes D, Sousa F, Lobo AC, Moura P. [Gestational Diabetes Mellitus: Is There an Advantage in Using the Current Diagnostic Criteria?]. ACTA MEDICA PORT 2018; 31:416-424. [PMID: 30189170 DOI: 10.20344/amp.10135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/11/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION There is no international consensus regarding gestational diabetes mellitus diagnostic criteria. In Portugal, the Carpenter and Coustan criteria were replaced by an adaptation of the International Association of Diabetes and Pregnancy Study Groups criteria. Our aim was to compare the incidence and outcomes of pregnancies complicated by gestational diabetes mellitus according to the current and previous criteria. MATERIAL AND METHODS Retrospective analysis of 1218 singleton pregnancies complicated with gestational diabetes mellitus, with surveillance/delivery between 2008-2015. Two groups were considered: identification according to the Directorate-General of Health criteria - International Association of Diabetes and Pregnancy Study Groups (group 1); identification through Carpenter and Coustan criteria (group 2). A comparative analysis was performed. RESULTS The incidence of gestational diabetes mellitus doubled (9.4% vs 4.6%), and the number of consultations/year increased (~3000 vs ~2000). In Group 1, in comparison with group 2, there was a lower risk of macrosomia in newborns [RR 0.44 (IC (95%):0.26 - 0.76)] and a higher risk of small for gestational age infants [RR 1.99 (IC (95%):1.19 - 3.31)]; a 6 - fold and 4 fold higher risk in neonatal hypoglycemia [RR 6.30 (IC (95%): 3.39 - 11.71)] and hyperbilirubinemia [RR 3.89 (IC (95%): 2.25 - 6.72)] were also observed, respectively. There were no differences regarding other outcomes. DISCUSSION Outcomes related to the decrease in macrosomia did now show any improvement, with even an increase in Small for Gestational Age and neonatal complications. Given the increased incidence of gestational diabetes mellitus, Directorate-General of Health - International Association of Diabetes and Pregnancy Study Groups criteria may be associated with greater healthcare-related costs due to more frequent consultations, with no apparent obstetrical/neonatal benefit. CONCLUSION The Directorate-General of Health - International Association of Diabetes and Pregnancy Study Groups criteria were associated with a decrease in macrosomia, not accompanied by an improvement of obstetrical/perinatal outcomes. The benefit of using these criteria is open to debate.
Collapse
Affiliation(s)
- Ana Filipa Ferreira
- Serviço de Obstetrícia A. Maternidade Daniel de Matos. Centro Hospitalar e Universitário de Coimbra. Coimbra.; Faculdade de Medicina da Universidade de Coimbra. Coimbra
| | - Catarina Miranda Silva
- Serviço de Obstetrícia A. Maternidade Daniel de Matos. Centro Hospitalar e Universitário de Coimbra. Coimbra. Faculdade de Medicina da Universidade de Coimbra. Coimbra. Portugal
| | - Dora Antunes
- Serviço de Obstetrícia A. Maternidade Daniel de Matos. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Filipa Sousa
- Serviço de Obstetrícia A. Maternidade Daniel de Matos. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - António Carlos Lobo
- Serviço de Obstetrícia A. Maternidade Daniel de Matos. Centro Hospitalar e Universitário de Coimbra. Coimbra. Faculdade de Medicina da Universidade de Coimbra. Coimbra. Portugal
| | - Paulo Moura
- Serviço de Obstetrícia A. Maternidade Daniel de Matos. Centro Hospitalar e Universitário de Coimbra. Coimbra. Faculdade de Medicina da Universidade de Coimbra. Coimbra. Portugal
| |
Collapse
|
6
|
Heidar Z, Bakhtiyari M, Foroozanfard F, Mirzamoradi M. Age-specific reference values and cut-off points for anti-müllerian hormone in infertile women following a long agonist treatment protocol for IVF. J Endocrinol Invest 2018; 41:773-780. [PMID: 29235049 DOI: 10.1007/s40618-017-0802-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 11/23/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of this study were to determining the reference value of anti-müllerian hormone (AMH) in infertile women and effect of AMH on different ovarian responses in the stratum of BMI categories. METHODS Through a retrospective cohort study the information of 816 infertile patients referring to the referral infertility clinic of Mahdiyeh Hospital since the beginning of 2011 until the end of January 2016 were used. The normal-based method was undertaken to calculate age-specific AMH percentiles. To determine the effect of AMH on the outcomes of different ovarian responses following adjustment of associated variables, the multinomial regression model was used. RESULTS Estimated reference intervals for AMH corresponding to the 2.5 and 97.5th‰ in patients with normal ovarian response are from 0.096 to 6.2 ng/mL. These values for percentiles of 5, 10, 25, 50, 75, 90, and 95% are, respectively, 0.18, 0.33, 0.77, 1.68, 3.05, 4.45, and 5.36 ng/dL. Also the reference value for the 20-year-old participants has a maximum range (0.12-7.64), while for 43-year-old ones has the lowest range (0.08-5.3). Among participants under and above 35 years old, the optimal cut-off points for predicting normal ovarian response are, respectively, 1.5 and 1.2 ng/dL. With each unit increase in the log of AMH concentration, the odds of having excessive ovarian response in patients with normal weight compared to that of having normal ovarian response is 32% higher. CONCLUSIONS Determining AMH reference values in IVF candidates allows specialists to measure only AMH plasma levels in IVF candidates so as to find whether or not the ovarian response is normal before applying other therapeutic measures; accordingly, they can adjust a treatment plan for each individual separately.
Collapse
Affiliation(s)
- Z Heidar
- Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Bakhtiyari
- Non-communicable Disease Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - M Mirzamoradi
- Department of Obstetrics and Gynecology, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Po.Box: 1185817311, Tehran, Iran.
| |
Collapse
|
7
|
Abstract
Ultrasound has become a core skill in many specialties. We evaluated the learning and assessment of ultrasound skills in Obstetrics-Gynaecology in a series of eight studies. In the clinical setting, we found that trainees as well as experienced clinicians struggle with technical aspects of performance such as image optimization. We examined how to improve these aspects of performance in the simulated setting by determining mastery learning levels and exploring learning curves for novices. We then examined how to improve the efficiency of training as well as transfer of learning through the use of dyad practice as compared with single practice. We found that the use of simulation-based training focusing on technical aspects of performance in addition to clinical training led to sustained improvements in performance after two months of clinical training in all aspects of performance. In addition, we found an interaction effect between initial simulation-based training and subsequent clinical training on trainees' need for supervision. These findings suggest that simulation-based training can work as preparation for future learning rather than merely as added learning. Finally, we found that the use of simulation-based initial training led to a large decrease in patients' discomfort, improvements in their perceived safety and confidence in their ultrasound operator. However, simulation-based training comes at a cost and in the final study we developed a model for conducting cost-effectiveness studies and provided data from an example study on how to link training costs with quality of care.
Collapse
|
8
|
Török M, Pasternak A, Hobel C, Korányi L, Doszpod J. Intercontinental videoconferences between US and Hungarian obstetricians: a 30-month study. J Telemed Telecare 2016; 10:236-8. [PMID: 15326734 DOI: 10.1258/1357633041424359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Over 30 months, 19 videoconferences were held between the Department of Obstetrics and Gynecology of the Cedars-Sinai Medical Center in Los Angeles and the Department of Obstetrics and Gynecology at the Semmelweis University in Budapest. Videoconferences used ISDN transmission at 384 kbit/s. In the main part of each videoconference a US expert presented various clinical topics. Every videoconference was recorded and later evaluated by two independent Hungarian researchers. The novelty of the information was scored on a Likert scale from 0 (low) to 10 (high). The novelty scores ranged from 0 to 8, with a tendency to low scores. There was a significant negative correlation between the novelty scores and the number of questions discussed during the videoconferences ( r = -0.63). There was also a significant negative correlation between novelty scores and the length of discussions ( r = -0.84). Medical expertise and practice were quite similar in the two institutions. The presentations on matters that were more familiar to the audience generated longer discussions and led to the sharing of experiences.
Collapse
Affiliation(s)
- Miklós Török
- Semmelweiss University, Faculty of Health Sciences, Budapest, Hungary.
| | | | | | | | | |
Collapse
|
9
|
Blake KR, Dixson BJW, O'Dean SM, Denson TF. Standardized protocols for characterizing women's fertility: A data-driven approach. Horm Behav 2016; 81:74-83. [PMID: 27072982 DOI: 10.1016/j.yhbeh.2016.03.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/09/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
Abstract
Experts are divided on whether women's cognition and behavior differs between fertile and non-fertile phases of the menstrual cycle. One of the biggest criticisms of this literature concerns the use of indirect, imprecise, and flexible methodologies between studies to characterize women's fertility. To resolve this problem, we provide a data-driven method of best practices for characterizing women's fertile phase. We compared the accuracy of self-reported methods and counting procedures (i.e., the forward- and backward-counting methods) in estimating ovulation using data from 140 women whose fertility was verified with luteinizing hormone tests. Results revealed that no counting method was associated with ovulation with >30% accuracy. A minimum of 39.5% of the days in the six-day fertile window predicted by the counting methods were non-fertile, and correlations between counting method conception probabilities and actual conception probability were weak to moderate, rs=0.11-0.30. Poor results persisted when using a lenient window for predicting ovulation, across alternative estimators of the onset of the next cycle, and when removing outliers to increase the homogeneity of the sample. By contrast, combining counting methods with a relatively inexpensive test of luteinizing hormone predicted fertility with accuracy >95%, but only when specific guidelines were followed. To this end, herein we provide a cost-effective, pragmatic, and standardized protocol that will allow researchers to test whether fertility effects exist or not.
Collapse
Affiliation(s)
- Khandis R Blake
- School of Psychology, Mathews Building, The University of New South Wales, UNSW, Sydney, NSW 2052, Australia.
| | - Barnaby J W Dixson
- School of Psychology, The University of Queensland, Brisbane St Lucia, QLD 4072, Australia
| | - Siobhan M O'Dean
- School of Psychology, Mathews Building, The University of New South Wales, UNSW, Sydney, NSW 2052, Australia
| | - Thomas F Denson
- School of Psychology, Mathews Building, The University of New South Wales, UNSW, Sydney, NSW 2052, Australia
| |
Collapse
|
10
|
Fischerová D, Frühauf F, Břešťáková L. [Diagnostic algorithm in pregnancies of uncertain viability or unknown location - a review of the latest recommendations]. Ceska Gynekol 2014; 79:231-238. [PMID: 25054961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Based on current knowledge the criteria for diagnosing nonviability in early intrauterine pregnancy and diagnostic algorithm in pregnancies of unknown location have changed. For either an intrauterine pregnancy of uncertain viability or a pregnancy of unknown location, the consequences of false positive diagnosis of nonviability or false negative diagnosis of ectopic pregnancy may be dire: harming of a potentially normal intrauterine pregnancy or a life-threatening rupture from tubal pregnancy. This review aims to present the most important results of current studies on this topic with their recommendations and to improve patient care reducing the risk of inadvertent harm to potentially normal pregnancies.
Collapse
|
11
|
American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of obstetric ultrasound examinations. J Ultrasound Med 2013; 32:1083-101. [PMID: 23716532 DOI: 10.7863/ultra.32.6.1083] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
12
|
Lie Fong S, Visser JA, Welt CK, de Rijke YB, Eijkemans MJC, Broekmans FJ, Roes EM, Peters WHM, Hokken-Koelega ACS, Fauser BCJM, Themmen APN, de Jong FH, Schipper I, Laven JSE. Serum anti-müllerian hormone levels in healthy females: a nomogram ranging from infancy to adulthood. J Clin Endocrinol Metab 2012; 97:4650-5. [PMID: 22993032 PMCID: PMC3683801 DOI: 10.1210/jc.2012-1440] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Anti-müllerian hormone (AMH) is an accurate marker of ovarian reserve. However, sufficiently large sets of normative data from infancy to the end of reproductive life are scarce. OBJECTIVE This study was an assessment of serum AMH levels in healthy females. SUBJECTS In 804 healthy females ranging from infancy until the end of the reproductive period, serum AMH levels were measured with an enzyme-linked immunometric assay. All adults had regular menstrual cycles. The majority was proven fertile and none of them had used oral contraceptive pills prior to study inclusion. RESULTS In the total cohort, AMH was inversely correlated with age (r = -0.24; P < 0.001). The age at which the maximum AMH value was attained was at 15.8 yr. In girls younger than 15.8 yr, serum AMH and age were positively correlated (r = +0.18; P = 0.007). Thereafter AMH levels remained stable (r = -0.33; P = 0.66), whereas from the age of 25.0 yr onward, an inverse correlation between AMH and age (r = -0.47; P < 0.001) was observed. At any given age, considerable interindividual differences in serum AMH levels were observed. CONCLUSION During infancy AMH levels increase, whereas during adolescence, a plateau until the age of 25 yr was observed. From the age of 25 yr onward, serum AMH levels correlate inversely with age, implying that AMH is applicable as a marker of ovarian reserve only in women of 25 yr old and older. Our nomogram may facilitate counseling women on their reproductive potential.
Collapse
Affiliation(s)
- S Lie Fong
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Kim SM, Romero R, Lee J, Mi Lee S, Park CW, Shin Park J, Yoon BH. The frequency and clinical significance of intra-amniotic inflammation in women with preterm uterine contractility but without cervical change: do the diagnostic criteria for preterm labor need to be changed? J Matern Fetal Neonatal Med 2012; 25:1212-21. [PMID: 21999173 PMCID: PMC3288712 DOI: 10.3109/14767058.2011.629256] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The objective of this study was to determine the frequency and clinical significance of intra-amniotic inflammation in patients with preterm increased uterine contractility with intact membranes but without cervical change. METHODS Amniocentesis was performed in 132 patients with regular uterine contractions and intact membranes without cervical change. Amniotic fluid was cultured for bacteria and mycoplasmas and assayed for matrix metalloproteinase-8 (MMP-8). Intra-amniotic inflammation was defined as an elevated amniotic fluid MMP-8 concentration (>23 ng/mL). RESULTS (1) Intra-amniotic inflammation was present in 12.1% (16/132); (2) Culture-proven intra-amniotic infection was diagnosed in 3% (4/132) of patients without demonstrable cervical change on admission or during the period of observation; and (3) Patients with intra-amniotic inflammation had significantly higher rates of preterm delivery and adverse outcomes, and shorter amniocentesis-to-delivery intervals than those without intra-amniotic inflammation (P < 0.05 for each). Adverse outcomes included chorioamnionitis, funisitis, and neonatal death. CONCLUSION Intra-amniotic inflammation was present in 12% of patients with regular uterine contractions without cervical change, while culture-proven intra-amniotic infection was present in 3%. The presence of intra-amniotic inflammation was a significant risk factor for adverse neonatal outcomes. These observations question whether cervical changes should be required for the diagnosis of preterm labor, because patients without modifications in cervical status on admission or during a period of observation are at risk for adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Sun Min Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
Pediatric gynecological examination is very simple, but usually unrecognized by physicians without a specific experience in pediatric gynecology. It is always necessary and most of the time sufficient in children and adolescents consulting for gynecological complaints, endocrine problems, or sexual abuse. However, accurate evidence-based data on its normality is poor in the literature, because of bias represented by the inclusion of abused patients in these studies. Our aim was to describe the preparation to a full gynecological examination, the adequate positions, and the sequence and technique required for a well-accepted and nontraumatic clinical examination. Normal findings are described depending on the age of the patient (child, newborn, adolescent), and are based on evidence from the literature. Indications for vaginoscopy and bacterial sampling are discussed according to the age of the patient. The most important factors in the achievement of a full gynecological examination and a trusting patient-physician relationship are a good anatomical and physiological knowledge of the genital system in children, and the learning of nonaggressive examination technical skills associated with good communication skills. Clinical examination is always necessary and most of the time is sufficient together with the medical history to diagnose and treat the child's gynecological problems. Evidence-based data on normal genital findings is poor in the literature, because many studies include abused children or present bias in the methods of recruitment and assessment of normal girls [1].
Collapse
|
15
|
Dilworth MR, Kusinski LC, Baker BC, Renshall LJ, Greenwood SL, Sibley CP, Wareing M. Defining fetal growth restriction in mice: A standardized and clinically relevant approach. Placenta 2011; 32:914-6. [PMID: 21889207 DOI: 10.1016/j.placenta.2011.08.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 08/02/2011] [Accepted: 08/14/2011] [Indexed: 11/15/2022]
Abstract
The increasing number of mouse models of fetal growth restriction (FGR) make it crucial to standardize the way FGR is defined. By constructing growth curves in the placental-specific Igf2 knockout mouse (P0) it was demonstrated that 93% of P0 fetuses fell below the 5th centile of wild-type weights at E18.5, up from 44% at E16.5. This analysis, coupled with anthropomorphic measurements showing evidence of head sparing in P0 fetuses, allows clinical comparisons of FGR in mice through the use of clinically relevant growth curves. We suggest this as a standardized approach to defining FGR in mouse, and other animal models.
Collapse
Affiliation(s)
- M R Dilworth
- Maternal and Fetal Health Research Centre, Manchester Academic Health Sciences Centre, School of Biomedicine, University of Manchester, 5th Floor Research, St Mary's Hospital, Oxford Road, Manchester M13 9WL, UK
| | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
BACKGROUND Antenatal screening for aneuploidy is an established routine clinical practice worldwide. The same statistical methodology, developed and refined over three decades, might be adapted to screening for pre-eclampsia. METHODS The published literature is reviewed for evidence that the methodology is valid for pre-eclampsia using first trimester maternal serum PP13, PAPP-A, PlGF, ADAM12 and inhibin A, together with MAP and uterine artery Doppler PI. Risk is estimated for both early onset pre-eclampsia, requiring delivery before 34 weeks, or late onset disease. Prior risk from the background prevalence multiplied by likelihood ratios (LRs) for ethnicity, parity, adiposity and family history is multiplied by an LR from the screening marker profile. Markers are expressed in multiples of the gestation-specific median and adjusted for body mass, ethnicity and smoking status as appropriate. A standardized population with a fixed distribution of risk factors and a multi-variate Gaussian model of marker profiles is used to predict performance. RESULTS There is sufficient published data to estimate individual risks reasonably well. Modeling predicts that using PAPP-A and one other serum marker, together with the physical markers more than two-thirds of early and one-third of late onset cases can be detected by classifying less than 2% of pregnancies as high risk; three-quarters of early case could be detected with a 5% high risk rate. CONCLUSION Whilst more data on some markers is still required modeling so far suggests that extending first trimester aneuploidy screening programs to include pre-eclampsia screening would yield a high detection. However, prospective studies are needed to verify the model predictions.
Collapse
Affiliation(s)
- H S Cuckle
- Department of Obsterics and Gynecology, Columbia University Medical Center, 622 W. 168th Street, PH1666, New York, NY 10032, USA.
| |
Collapse
|
17
|
Martinuzzi K, Mariona F. Comment and reply on: The clinical significance of a positive Amnisure test in women with term labor with intact membranes. J Matern Fetal Neonatal Med 2010; 24:654; author reply 654-6. [PMID: 20459341 DOI: 10.3109/14767051003750900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
18
|
Spurgeon D. Canadian woman seeks class action suit over breast cancer tests. BMJ 2009; 338:b2491. [PMID: 19553262 DOI: 10.1136/bmj.b2491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
19
|
Nau JY. [Ovary cancer: the OvaSure affair]. Rev Med Suisse 2008; 4:2065. [PMID: 18946969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
20
|
Acevedo Gallegos S, Guzmán Huerta ME, Velázquez Torres B, Gallardo Gaona JM, Sarmiento Sánchez LA. [Application of a technique to establish criteria for uterine length measurement]. Ginecol Obstet Mex 2007; 75:465-470. [PMID: 18293676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND The uterine length measurement is a routine practice in the prenatal care of pregnant women. It has been attributed a sensibility of 86% to detect fetal grown restriction. The technique is easy to perform and reproducible between observers, although we have found variation between intra- and inter-observers measurements. OBJECTIVE To evaluate the useful of a maneuver to improve the reliability of the uterine length measurement in a group of obstetrics residents. MATERIAL AND METHODS The measurement was performed on pregnant women. The results were analyzed by intraclass correlation coefficient to evaluate the concordance between observers based in a variance analysis model (ANOVA) of repeated measurements. RESULTS There were not differences between groups about demographic variables. All residents improve the reliability in their measurements. The intra-class correlation coefficient was 0.77 (confidence interval 0.63-0.88) before the maneuver, and after this one the intra-class correlation coefficient improved to 0.96 (confidence interval 0.92-0.98). CONCLUSION The uterine measurement following detailed indications improve the interobserver concordance. We think it is advisable to evaluate the use of this maneuver in a routine way in our institute and in other places that bring prenatal care.
Collapse
|
21
|
Khan KS, Bakour SH, Bossuyt PM. Evidence-based obstetric and gynaecologic diagnosis: the STARD checklist for authors, peer-reviewers and readers of test accuracy studies. BJOG 2004; 111:638-40. [PMID: 15198751 DOI: 10.1111/j.1471-0528.2004.00218.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Khalid S Khan
- Education Resource Centre, Birmingham Women's Health Care NHS Trust, UK
| | | | | |
Collapse
|
22
|
|
23
|
Shrier LA, Dean D, Klein E, Harter K, Rice PA. Limitations of screening tests for the detection of Chlamydia trachomatis in asymptomatic adolescent and young adult women. Am J Obstet Gynecol 2004; 190:654-62. [PMID: 15041995 DOI: 10.1016/j.ajog.2003.09.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the performance of different test types, specimen sources, and collection methods for screening of genital Chlamydia trachomatis infection in young women. STUDY DESIGN Asymptomatic women aged 16 to 25 years collected their own vaginal swabs and a first-voided urine specimen; a clinician collected urethral, vaginal, and endocervical swabs for culture and nucleic acid amplification tests, polymerase chain reaction and ligase chain reaction. A positive culture, 2 positive nucleic acid amplification tests, or 1 positive nucleic acid amplification test confirmed by a separate nested polymerase chain reaction comprised the criterion standard to define a C. trachomatis-infected woman. RESULTS The prevalence of C. trachomatis was 22% (30/139 women). All 9 test results were available for 126 participants (91%). Sensitivities were comparable for polymerase chain reaction and ligase chain reaction (52%-63%), except for urine polymerase chain reaction (44%), and were lower for culture (22%-37%); specificities were 99% to 100%, except for urine ligase chain reaction (91%). Positive predictive values were >93%, except for urine ligase chain reaction (65%); negative predictive values were 83% to 91%. Combining nucleic acid amplification test results from 2 different specimens improved sensitivities without compromising specificity. CONCLUSION When C. trachomatis infection was defined by multiple tests from different specimen sources, the sensitivity of any 1 test from a single specimen source was lower than generally reported. The limitations of the use of a single test to identify C. trachomatis infection should be considered when test type, specimen source, and collection method for screening young women is being determined.
Collapse
Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Mass, USA
| | | | | | | | | |
Collapse
|
24
|
Watrelot A, Nisolle M, Chelli H, Hocke C, Rongières C, Racinet C. Is laparoscopy still the gold standard in infertility assessment? A comparison of fertiloscopy versus laparoscopy in infertility. Results of an international multicentre prospective trial: the 'FLY' (Fertiloscopy-LaparoscopY) study. Hum Reprod 2003; 18:834-9. [PMID: 12660280 DOI: 10.1093/humrep/deg180] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this prospective multicentre study was to compare the two endoscopic techniques of laparoscopy and fertiloscopy in routine evaluation of the pelvis in infertile women. METHODS A total of 92 women was selected in 14 University Hospitals to undergo fertiloscopy followed by transabdominal laparoscopy by a team of two surgeons in each hospital. RESULTS A high degree of concordance was observed between these two techniques, in that if fertiloscopy did not detect any abnormalities, this was also confirmed by laparoscopy. Discordance was observed in similar numbers of cases: eight after laparoscopy and nine after fertiloscopy. The diagnostic index for fertiloscopy and laparoscopy was calculated; sensitivity (86 and 87% respectively) and negative predictive value (64 and 67% respectively) were similar. The kappa index was also calculated for each of the six structures/regions (right/left tube; right/left ovary; peritoneum of pouch of Douglas; posterior uterus), and concordance (0.78 to 0.91) was considered almost complete. CONCLUSIONS These results confirm fertiloscopy as a minimally invasive safe procedure that may be considered as an alternative to diagnostic laparoscopy in the routine assessment of women without clinical or ultrasound evidence of pelvic disease. On the basis of the additional advantages of fertiloscopy, namely salpingoscopy or microsalpingoscopy, it is considered that fertiloscopy could replace laparoscopy as a routine procedure in such women.
Collapse
Affiliation(s)
- A Watrelot
- Centre de Recherche et d'Etude de la Stérilité, 69003-Lyon, France.
| | | | | | | | | | | |
Collapse
|
25
|
Yoshida M, Jimbo H, Shirai T, Takahashi M, Shiromizu K, Kuwabara Y. A clinicopathological study of postoperatively upgraded early squamous-cell carcinoma of the uterine cervix. J Obstet Gynaecol Res 2000; 26:259-64. [PMID: 11049235 DOI: 10.1111/j.1447-0756.2000.tb01319.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the clinicopathological backgrounds and diagnostic problems of postoperatively upgraded early squamous-cell carcinomas of the uterine cervix. PATIENTS AND METHODS A total of 23 patients with postoperatively upgraded early squamous-cell carcinomas who were treated at the Saitama Cancer Center during the period of January 1, 1976, through December 31, 1991, were analyzed clinicopathologically. We reexamined the Pap smears (ectocervix, endocervix), colposcopic findings, punch biopsies, and histological findings of the operative specimens. All patients were divided into one of 3 groups based on each patient's main location of the carcinoma of the cervix: Type A: ectocervical type; Type B: endocervical type; or Type C: combined (ectocervical and endocervical) type. Clinical staging of the uterine cervical carcinomas was done in accordance with the 1994 FIGO rules. RESULTS The numbers of patients were: Type A, 2; Type B, 10; Type C, 11. Of the 23 patients, 21 (91.3%) had lesions in the endocervical portion at least. Fifteen patients (65.2%) complained of atypical vaginal bleeding. Colposcopic findings suggesting an invasive carcinoma appeared for only 6 patients (26.1%). A cytological reevaluation revealed that the endocervical findings were much stronger than the ectocervical ones in 10 (66.7%) of 15 patients whose smears of both sites could be rechecked. CONCLUSIONS Even if the preoperative diagnosis was early cervical carcinoma, CIS or Stage Ia1, the signs of atypical vaginal bleeding suggested that the final clinical stage would be upgraded after an operation. Furthermore, when the endocervical cytological findings were much more exaggerated than the ectocervical ones, the possibility of deeply invaded endocervical lesions should be considered.
Collapse
Affiliation(s)
- M Yoshida
- Division of Gynecology, Saitama Cancer Center, Saitama, Japan
| | | | | | | | | | | |
Collapse
|
26
|
Lobert PF. Human sensitivity vs automation. Am J Clin Pathol 1998; 110:550-1. [PMID: 9763039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
|
27
|
Cohen MB. A conflict of interest? Am J Clin Pathol 1998; 110:549. [PMID: 9763038 DOI: 10.1093/ajcp/110.4.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|